For a couple of decades, I have been using a drug to manage my asthma. My asthma is mild, but it's in need of control. With the assistance and supervision of my primary care physician, I've gone from having bronchitis several times a year and frequently wheezing, to (knock on wood) going several years between bronchitis episodes, and rarely wheezing. This is a good thing, a very good thing.
Recently, a generic became available for the drug I've been using (Advair). And I considered that to also be a good thing. Unfortunately, we recently changed insurance to Blue Cross Blue Shield. And apparently, that was a bad thing.
You see, according to Blue Cross Blue Shield's policy on asthma medications, they will not approve Advair OR the new generic for Advair, until/unless the patient has first tried two other asthma medications. EVEN IF the patient has been on Advair for some time, with good results. EVEN THOUGH the other medications warn that it may take a bit of time for a patient to begin to feel the full benefit of the other medications.
So I began using the first of the other options. And this was not a good thing.
I filed an appeal with Blue Cross Blue Shield (see letter at the bottom of this post), and this evening my primary care physician called me to say she'd been notified by Blue Cross Blue Shield that 'they needed a more complete history' for me. Mind you... the doctor's office had already submitted a complete history when they requested the authorization for the generic of Advair. And they've done this many times before, for other patients and other drugs. So it's not as if they don't know what they're doing. Whatever the end result of this might be, I find it ridiculous that the group practice my doctor belongs to has to have a staff person whose job is to research and review patient histories and write up requests for authorization. I find it ridiculous that Blue Cross Blue Shield's actions result in my doctor calling me at 5:30 on a Friday night, to report what she's doing to try to make this work... I know she works long days and she should have better things to do than jump through Blue Cross Blue Shield's hoops.
Yes, I realize some drugs can be outrageously expensive. Yes, I understand that Big-Pharma is partly to blame. If Big-Pharma is the problem, then Blue Cross Blue Shield should focus their efforts in that direction. Yes, I'm sure there are doctors out there who will prescribe anything, willy-nilly, without regard to whether there are other options. If irresponsible doctors are the problem, then Blue Cross Blue Shield should require explanations of why a patient is on a specific drug... Oh wait, they do. But this just feels too much like the blind application of a policy, without regard or thought to a specific situation. Which makes Blue Cross Blue Shield an irresponsible party to all of this.
I feel very fortunate to have a doctor willing to put in the time and effort to see this through.
In the meantime, this is why I hate insurance companies.
Sometimes, tea is not enough, you have to take other action.
